A couple sits close, intently studying a dossier. On the    dossier is a list starting with Embryo #1.  
    According to the description, Embryo #1 is female, has a high    risk of Type II Diabetes, will have blue eyes and blond hair,    and has a 20% chance of being in the 90th percentile for math    ability.  
    Alternatively, Embryo #100 is male, will have blue eyes and    dark hair, has a 60% chance of being in the top 10% for musical    ability, and is at a high risk for depression.  
    Between Embryo #1 and #100 lie similarly detailed descriptions.  
    While this may sound like science fiction, according to Hank    Greely, Dean F. and Kate Edelman Johnson Professor of Law at    Stanford University, this scenario is the soon-to-be future of    human reproduction.  
    I predict in [my] book [The End of Sex and the Future of    Human Reproduction] that in 20 to 40 years the majority of    babies born to people with good health coverage anywhere in the    world will not be conceived in a bed or in the back of a car or    under a keep off grass sign, but will be conceived in a lab    so that parents can then do whole genome sequencing and pick    the embryo that they want, Greely said during his Gladstone GO    Graduate Student Organization sponsored bioethics seminar on    April 14.  
    Greely went on to share several stories about advances in human    reproduction that will make this future he envisions possible,    starting with preimplantation genetic diagnosis (PGD).  
    A three day embryo is like eight grapes inside a water balloon    thats filled with jello, Greely explained. The grapes really    arent attached to each other, so what you [do is] make a    little hole in the water balloon--the membrane holding the    embryo together and suck out one of those cells. And the    other seven cells [do] fine, they [do] not fail at any higher    rate than embryos regularly fail, and you take that cell and do    genetic testing on it.  
    According to Greely, PGD has been clinically available for 25    years, but recently scientists have been using five- or    six-day-old embryos from which they can take five, 10, or even    15 cells, thus allowing for more confidence in the genetic    testing results.  
    This procedure, however, is currently limited by the expense of    sequencing, the short time frame between taking cells from the    embryo for genetic testing and implanting the embryo, and our    understanding of genetics.  
    As sequencing becomes cheaper and allows our knowledge of    genetics to grow, Greely predicts that PGD will advance to what    he calls enhanced PGD, in which cells taken from embryos will    have their entire genome sequenced.  
    Another huge limitation to PGD is that before you can run    genetic tests you first must harvest eggs from the female.  
    Normally women ripen one or at most two eggs a month, Greely    said. If youre going to go in [for] this invasive procedure    you want as many ripe eggs as possible. Very expensive hormones    [are used] in order to convince more eggs to ripen than normal.    This causes cramping, bloating, mood swings, unpleasantness as    well as the fact that [the woman] has to give herself a shot    every day for 30 days in a row which people, understandingly,    find a little bit disconcerting.  
    Furthermore, although a small percentage, some women who go    through egg harvesting end up hospitalized or may even die.  
    Nobody goes through IVF [in vitro fertilization] just for the    heck of it, Greely said. They do it because they have to.  
    Importantly, Greely also stresses that this unpleasantness and    risk all falls on the female.  
    So what can we do to move away from current methods of egg    retrieval? Greely believes the answer is induced pluripotent    stem cells (iPSCs).  
    iPSCs are generated by reprogramming adult cells in a way which    induces a loss of their defined cellular identity. In this    state the cell now has the the potential to differentiate into    any cell type, whether it be an epithelial cell, a    cardiomyocyte, or an oocyte.  
    Greely thus envisions a world in which an individual would give    a skin biopsy that would be reprogrammed to become iPSCs which    would then be used to make oocyte precursors and finally an    oocyte that could be fertilized.  
    This method, known as in vitro gametogenesis (IVG), could also    be used on skin biopsies from males to generate oocytes or skin    biopsies from females to generate sperm, thus making it    possible for same sex couples to have children who are    biologically related to both parents.  
    Additionally, instead of harvesting only a few eggs, IVG could    potentially generate hundreds of eggs non-invasively.  
    Taking it a step further, whole genome sequencing (WGS) could    be performed on all fertilized eggs to generate genetic    profiles of each embryo. Parents could know whether the embryo    is at high risk for early onset disease or other diseases and    medical conditions. They could also learn about the cosmetic    make up, behaviors, and sex, and use all this information to    help them choose the embryo they want implanted.  
    One important caveat to this scenario, however, is that rarely    do traits adhere to simple Mendelian genetics with one gene    coding for one trait.  
    Its all going to be really complicated, Greely stated.    Probably involving hundreds or thousands of different genetic    loci and with a big dollop of environment and chance.  
    Another issue is how parents will parse through all this    information.  
    Even if youre only looking at 20 different things of    significance how do you weigh 50% higher risk of Type II    Diabetes versus 50% lower risk of schizophrenia versus 50%    chance of being in the top 10% for music ability versus [being]    very, very tall? Greely asks. Its going to be a real hard    decision.  
    Thus, an important aspect of this future Greely envisions will    be educating parents to help them make informed decisions that    they will ultimately feel comfortable with.  
    Despite this being a bioethics seminar, Greely only discussed a    few ethical quandaries.  
    For instance, if you can take anyone's cells and make them into    eggs and sperm, then anyone can be a genetic parent. A    50-year-old woman could become a mother, but an eight-month old    baby or a woman who died and whose cells were frozen could both    also become genetic parents.  
    While Greelys point seemed to be that this would change family    structures, I think the real issue at the crux of this is legal    regulation, which Greely didnt touch too much on in his talk.  
    One of the most challenging moral dilemmas associated with this    future of human reproduction was, surprisingly, not brought up    until the question was posed by an audience member.  
    As technology like PGD becomes more available and more    powerful, will we lose populations of people?  
    For example, if you knew that an embryo would give rise to a    child who was deaf, autistic, or achondroplastic would you    chose against that embryo? And if you and others choose against    that embryo how will that impact our society?  
    For one, it will decrease the number of individuals who make up    that community thus decreasing research, social, and political    support for this community.  
    Additionally, if parents tend to select against these traits it    may send the message that these traits are bad and that    individuals who do have these traits are leading lives that    arent worth living.  
    But how does one determine what is and isnt a life worth    living?  
    While society as a whole might label certain traits like those    listed above as disabilities, members of these communities    dont all hold that view, instead seeing it as a different way    of being. For example, autism is sometimes thought of as    neurodiversity.  
    How will beliefs like this affect a parents choice? Will an    individual who is deaf select to have a deaf child?  
    This leads to a whole new set of issues Greely also did not    cover.  
    In the future, will parents be discriminated against for    choosing certain traits for their children or for choosing to    procreate the old fashion way instead of selecting their child    based on traits that society sees as favorable? What new power    dynamics will these technologies create?  
    Greely also failed to talk about issues surrounding    availability of this technology.  
    While he hypothesizes that health care programs will fully pay    for IVG and WGS--as in the long run it will ultimately reduce    healthcare spending--this coverage isnt going to happen    instantly. In the beginning, these processes will still be    expensive and likely only available to those with enough money.  
    If wealthy individuals are screening their embryos to ensure    the healthiest embryo is implanted, what will this mean for    populations who cant afford this service? It seems very    possible that the burden of health care expenses could fall    entirely on them.  
    Additionally, this could impact the amount of money funneled    into biomedical research whether it be because individuals feel    they no longer need to donate to a cause that doesnt affect    them or because research in that field no longer seems like a    priority due to a shrinking community of affected individuals.  
    All of this, however, is dependent on how much information we    will actually be able to glean from an embryos genetics alone.  
    Greely believes that cheap sequencing changes everything and    while it will definitely lead to advancements, it may not be as    comprehensive as Greely predicts.  
    Despite what I believe to be Greelys slightly over-optimistic    vision, his last point rings true.  
    If we understand the issues better in advance we are less    likely to screw up.  
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The Future of Genetics - Synapse